An attorney’s role in developing medical evidence in an SSDI case

An application for Social Security Disability Insurance must be supported by objective medical evidence.

Eligibility for Social Security Disability Insurance must be based on objective medical evidence of severe disability that prevents a claimant from working. The laws and regulations are extremely complex, as is the application and appeal process. Most initial applications are denied, often because the claimant's file does not contain medical evidence supporting disability as it is defined by the Social Security Administration, the federal agency that administers Social Security benefit programs like SSDI.

The definition of disability for SSDI purposes is unique and different from those that apply in workers' compensation or private disability insurance claims. To be disabled, the SSDI claimant must have a severe medical impairment (physical or medical) or combination of impairments expected to last at least one year or result in death that prevents the person from working. Whether or not a person can find work is not considered.

In order to properly assess whether an applicant's condition falls within this definition, SSA has the legal duty to develop a claimant's medical record by gathering evidence from treating sources. If necessary, it will refer a claimant for further medical assessment if an impairment is alleged for which adequate medical evidence is not available.

Practically speaking, however, the agency does not always develop the medical record to the level at which an informed decision can be made, leaving the burden on the claimant to supplement his or her medical evidence. However, most people do not understand what is required so legal representation is a smart idea. An experienced SSDI lawyer will know the law and the level and kind of objective medical evidence needed to support an application.

Legal counsel who represent SSDI claimants on a regular basis will have a thorough, detailed procedure for developing the record, probably including:

  • Detailed forms for the client to complete, asking for information about medical conditions and about all treating doctors
  • Requests for records from medical treating sources
  • Interviews with the client to understand his or her impairments, the symptoms and limitations they cause and how this impacts the ability to perform basic work activities. Examples include walking, standing, sitting, bending, reaching, concentrating, following directions and so on.
  • Referral of the client for further medical evaluation when a medical condition has not been properly assessed
  • Use of SSA electronic filing technology to submit medical evidence to the agency on behalf of the client

This article introduces a complicated area of SSDI law and procedure. Questions in any individual case should be directed to a claimant's lawyer.

The St. Louis attorneys at Crowe & Shanahan advocate for SSDI claimants in the St. Louis area, eastern Missouri and southern Illinois.